Basic Information
Provider Information
NPI: 1033558481
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SCHARINE
FirstName: DENIS
MiddleName: C
NamePrefix:  
NameSuffix:  
Credential: D.D.S.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 403 WOLF RIVER DR
Address2: PO BX 500
City: FREMONT
State: WI
PostalCode: 549409038
CountryCode: US
TelephoneNumber: 9204462213
FaxNumber: 9204462215
Practice Location
Address1: 403 WOLF RIVER DR
Address2: PO BX 500
City: FREMONT
State: WI
PostalCode: 549409038
CountryCode: US
TelephoneNumber: 9204462213
FaxNumber: 9204462215
Other Information
ProviderEnumerationDate: 06/19/2013
LastUpdateDate: 06/19/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1223G0001X2944-015WIY Dental ProvidersDentistGeneral Practice

ID Information
IDTypeStateIssuerDescription
132610523005WI MEDICAID


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